Monday, August 17, 2009

The truth about health care's 'death panels'

I find it rather interesting and very disconcerting that all the news articles on the provisions in the health care bill say, in one way or another, that the idea of 'death panels' has been 'widely refuted.' The 'proof' of the denial is that President Barack Obama, or some other politician, has said so.

But none of the articles I've seen actually include any of the language from the bill, only the quotes from the politicians, even ones who admit they've not read the legislation.

While you will not find the term 'death panel' anywhere in the bill, there are reasons that Americans believe such a possibility will be in their future.

HR 3200, the America's Affordable Health Choices Act of 2009, contains Section 1151 on "reducing potentially preventable hospital readmissions." Here's what the bill actually says:

(ii) EXCLUSION OF CERTAIN READMISSIONS.—For purposes of clause (i), with respect to a hospital, excess readmissions shall not include readmissions for an applicable condition for which there are fewer than a minimum number (as determined by the Secretary) of discharges for such applicable condition for the applicable period and such hospital.

In order to determine what this means, you need several definitions from the bill:

(A) APPLICABLE CONDITION.—The term ‘applicable condition’ means, subject to subparagraph (B), a condition or procedure selected by the Secretary ...

(E) READMISSION.—The term ‘readmission’ means, in the case of an individual who is discharged from an applicable hospital, the admission of the individual to the same or another applicable hospital within a time period specified by the Secretary from the date of such discharge.

So government gets to decide what is an 'applicable medical condition,' who is allowed to be re-admitted to a hospital, the decisions will be based partially upon discharge statistics (if enough people with same condition have been discharged, you can be admitted), and there is no judicial review of the decisions - the Secretary has the ultimate decision.

Don't believe me on the lack of judicial review? From the bill:

"6) LIMITATIONS ON REVIEW.—There shall be no administrative or judicial review under section 1869, section 1878, ..."

This is, in effect, a process by which government decides who gets treatment and who doesn't. If you're the one not getting treatment, for whatever reason, and lack of treatment may result in your death, is it unreasonable for people to describe such a process as a 'death panel' - a group, board, commission or 'Secretary' making decisions about life and death?

The government will also evaluate various treatment options and determine which treatments are the most effective (Comparative Effectiveness Research section). Various criteria will be established by the government, including determination as to whether or not research on a treatment is 'credible' and meets the government criteria for acceptable research (see prior post on this section).

This is a one-size-fits-all approach to treatment options. Only your doctor can determine which treatment options are best for you, based upon your medical history and other aspects of your health and illness. What happens if the treatment best for you isn't on the government's 'acceptable' comparative effectiveness listings? Either they won't fund it and/or they restrict insurance companies from funding it and/or they prevent doctors from recommending it by refusing reimbursements through Medicaid/Medicare.

Regardless, the way the law is written presents the possibility that some panel or bureaucracy in Washington, D.C. will have the ability to dictate that a life-saving treatment for you won't be allowed. Again, is it any wonder that people look at this as a 'death panel' making life and death decisions?

The other has to do with the 'end-of-life' counseling sessions. In 2003, many members of congress, Republicans included, supported a provision that would allow Medicare to pay for 'end-of-life' counseling when a patient was terminally ill and/or in hospice care. HR 3200 expands this counseling to every five years for any senior participating in Medicare, or more often if their health conditions change and they, for instance, enter a nursing home or assisted-care facility.

When you run the numbers on this, you'll see that it may be impossible - or extremely costly - for government to implement this provision. Based upon every senior citizen having a session every five years, the government would have to conduct 55,000 counselings per day. Assuming that the session to cover such a critical issue would last about an hour, you'd need roughly 7,000 practitioners to conduct these sessions in a 8-hour day. (per Glen Meakem in his presentation to RightOnLine)

The media likes to belittle the people who use the term 'death panel' and make them appear crazy. It's not crazy to be afraid of turning over life and death decisions to government - or anyone other than yourself.

What's crazy is for the main stream media to take a politician's word on what is or isn't present in a particular bill. We've had way too many examples of unintended consequences and claims of 'I didn't know that would happen' from politicians who've supported and voted for measures in the past.

The lesson here is not to trust the politicians, the media - or even me and other bloggers. Read the bill yourself. I've linked to it in numerous posts, so there's no excuse for you to not be informed about what it says and to ask questions of Congress (if you can find one of them) about what these terms really mean when put into practice - or to hold them accountable for not being able to 'promise' what other people (like the Secretary of a Department with complete decision-making outside of judicial review) will do in the future with the power this bill will give them.

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